mHealth

Improving opportunities for better care

Jeanine Vos, Executive Director
mHealth, GSMA.

Mobile technologies are making a significant contribution to addressing the enormous challenges of healthcare provision worldwide. As the market for mobile healthcare solutions reaches the next stage in its development, greater consideration is being given to the regulatory frameworks that will govern their promotion and use.

Being the current major trend, is mHealth's promise to change the practice of medicine being met?

One of the biggest challenges facing societies worldwide is how to make high-quality healthcare afforable and accessible for all. As the population expands in developing countries and ages in developed countries, the world is spending an increaingly high proportion of its Gross Domestic Product (GDP) on healthcare Governments, individuals and private insurers worldwide are urgently seeking more cost-effective ways of preventing and treating chronic diseases and other debilitating conditions.

The widespread use of mobile connectivity in healthcare, called mHealth, could significantly cut costs, increase the reach and accessibility of healthcare services and reduce the impact of illness on people’s lives.

The GSMA tracks mobile health deployments around the world, and our database today counts over 800 services and over 200 mobile health devices. However, I would still not yet classify mHealth as having reached large scale adoption.

Barriers still remain, for example, being a new innovative service, it is not always clearly understood how existing regulations apply to mHealth, and only few solutions are being reimbursed by insurers or governments. Also, awareness of mobile health solutions by healthcare practitioners and people working in the pharmaceutical industry remains low, and mHealth is at present not regularly prescribed.

The GSMA commissioned end-user research to investigate what healthcare practitioners and patients currently consider main challenges in managing chronic conditions today, and what they see would be the role and potential benefits of mHealth. The research was conducted among 2,000 end users in India, China, US and Brazil. What I found interesting is that, on the one hand, an impressive 89 per cent of healthcare professionals believed mHealth had significant benefits to improve healthcare outcomes and reduce costs. On the other hand, almost 90 per cent of patients indicated that they are not using mHealth solutions at the moment, simply because their healthcare practitioners do not recommend them. In India, the number one barrier stated by patients to their increased use of mHealth solutions was lack of healthcare practitioners prescribing them. Therefore, I still see significant work needs to be done before real scale will be achieved.

What is your take on the existing regulatory standards for mHealth?

Mobile technologies are making a significant contribution to addressing the enormous challenges of healthcare provision worldwide. As the market for mobile healthcare solutions reaches the next stage in its development, greater consideration is being given to the regulatory frameworks that will govern their promotion and use.

Mobile health brings together healthcare and telecommunications industries, which both have specific policy and regulatory environments. This raises questions and uncertainties, such as, how do medical device regulations apply to mobile health solutions? How can existing legislation for data protection in telecom networks be translated into a healthcare setting?

Medical device regulation is essential in assuring patients’ and users’ safety. Safety for end-users is and should be at the centre of mHealth solutions and is essential in

creating the foundations to ensure trust in services. It is, therefore, important to ensure it is clear how this regulation applies to mobile health.

The use of standards has been a key element in establishing medical device regulations. The GSMA strongly embraces the adoption of global, consensual standards. Markets for mHealth are increasingly global and interdependent. Global standards are, therefore, key to ensuring economies of scale can be achieved and innovation can flourish. We encourage adoption of current medical device and software standards when developing mobile medical products.

Overall, I would encourage constructive discussion between industry and national regulators to help bring clarity and make sure that these new technologies can enter the market swiftly to deliver on the benefits to patients and healthcare professionals.

Are the existing applications of mHealth serving the purpose?

The GSMA research showed that almost 50 per cent of healthcare practitioners believe that patients lack full understanding of their condition, with 42 per cent of patients identifying that they are struggling to achieve their disease goals and now looking for help.

mHealth offers a portal to address this need. Real-time data capture and analysis, increased access to information, increased patient ownership and understanding of their condition, support with diet / lifestyle changes, improved compliance with medications; these perceived benefits of mHealth solutions all go towards improving the overall quality and efficiency of patient care.

One of the mHealth applications is called DiabetesManager®, launched by AT&T mhealth Solutions and WellDoc® in 2011. Through this application, a patient can enter their blood glucose readings, medication information, and other lifestyle information into DiabetesManager®, which through the use of a clinical

analytics engine provides automated, real-time feedback on the patient’s specific data. This way, the patient can take immediate action to help manage their disease. This valuable patient information is also made available to nurses, case workers and doctors who can review the information through an enterprise portal and provide additional communication to the patient, if needed, about what action he or she needs to take.

What kind of technology backbone needs to be in place for a successful mHealth strategy? Are legacy systems a major hurdle?

The history and success of the mobile industry is built on the application of common standards. This has been underpinned by a commitment to interoperability from multiple network operators and equipment suppliers. The nascent mobile health industry will benefit from applying these same principles to accelerate market growth and increase the value it delivers.

The GSMA has explored several standards that already exist within the health information arena. Through discussions with industry experts, the GSMA has identified four key functional areas that could benefit from further standardisation:

Communications: Consisting of the raw communications protocols and services

Data and records: Consisting of the mechanisms to codify clinical information and also store this information in an organised health-record format

Identity and Access: Consisting of the non-functional components around patient identity, patient confidentiality and consent, and security around the solutions

Service and Application: consisting of the functional healthcare specific application components that interface with existing systems and business functions

To accelerate the development and adoption of mHealth devices and solutions, the GSMA is engaging with the wider ecosystem and working with key players to understand their needs and to reduce the barriers to adoption.

What are the key challenges in deploying mHealth and how can these be managed?

GSMA has identified number one key barriers that need to be addressed in order to unlock the latent potential of mHealth. The main barriers are limited awareness of mHealth by healthcare professionals and patients, lack of clear policy and regulatory frameworks, lengthy reimbursement processes and change management requirements by healthcare providers.

To address these barriers the GSMA is bringing together its mobile industry members and health stakeholders to collaborate to enable scaled integration of mobile and information and communications technology into health systems. GSMA has regularly organised working groups and workshops, as well as provided resources and support to identify and diagnose opportunities and bring solutions to scale.

What is the scenario in Asia?

We have seen a significant increase in different mHealth solutions being deployed – ranging from decision support tools or remote diagnostics for healthcare professionals in remote communities, health hotlines where individuals have a first advice on primary care questions, to remote monitoring solutions for chronic patients.

Figures from the GSMA, developed in collaboration with PricewaterhouseCoopers (PwC) for a global report entitled ‘Mobile Health – Enabling Healthcare’, indicates that the Asia-Pacific mobile health market is expected to continue to grow significantly, to almost US$7 billion in 2017 at a CAGR of approximately 70 per cent. The largest opportunity across the region include monitoring services, with a 55 per cent market share in 2017, and diagnostic services, with a 24 per cent market share.

China is expected to have the biggest mobile health market in 2017, driven by growth in monitoring and diagnosis that will facilitate the delivery of effective healthcare to a widely spread population who have limited health access at present. In India it is expected that mobile diagnostics solutions will create the biggest opportunity due to the large proportion of the population living in rural areas.

Any other comments?

As shown in the GSMA end-user research, healthcare providers believe that mHealth solutions offer the opportunity to improve the quality of patient care, improve efficiency of work and reduce costs per individual. For the pharmaceutical industry, mHealth solutions offer the opportunity of improved adherence to medicines, thereby allowing their true value to be seen, as well as opportunities to work more closely with HCPs and patients, to explore new ways of working together to improve health. Other benefits include supporting clinical trials to obtain real world data and helping to advance research and development. The possibilities and opportunities that mHealth can offer in all countries are enormous across both public and private healthcare providers.

Author BIO

Jeanine Vos is leading the global mobile health (mHealth) programme at the GSMA which aims to stimulate the development and take-up of sustainable and scalable mHealth solutions. Jeanine is responsible for defining strategic direction of the programme, working closely with member companies and stakeholders across healthcare ecosystem.